Cried Blind: Valsalva Retinopathy After Emotional Stress in a Young Woman

A 23-year-old woman presented with sudden, severe vision loss in her right eye following intense emotional crying. Visual acuity was reduced to counting fingers with an unremarkable anterior segment examination. Fundus examination revealed a well-circumscribed, dome-shaped sub-internal limiting membrane hemorrhage involving the macula, with a visible fluid-blood level. Optical coherence tomography confirmed separation of the internal limiting membrane with a hyporeflective blood-filled cavity, consistent with sub-internal limiting membrane hemorrhage. Based on the characteristic imaging findings and a clear history of a Valsalva-like event, Valsalva retinopathy was diagnosed. Given the extensive macular involvement and the presence of fresh, non-clotted hemorrhage, neodymium-doped yttrium aluminum garnet laser membranotomy was performed at the lowest point of the hemorrhagic cavity. Immediate drainage of blood into the vitreous cavity was observed, accompanied by rapid visual improvement. Visual acuity improved to LogMAR 0.5 shortly after the procedure and further to LogMAR 0.2 at one-week follow-up. Subsequent fundus imaging demonstrated near-complete resolution of both sub-internal limiting membrane and intravitreal hemorrhage, and fundus fluorescein angiography showed no retinal structural damage. This case highlights intense emotional crying as a potential trigger for Valsalva retinopathy and supports early laser membranotomy as an effective treatment for macula-involving cases.